B0489 - In-hospital Characteristics and Healthcare Utilization of NASH-Related SBP vs Non-NASH-Related SBP - A Study Based on Nationwide Inpatient Database

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Pranav D. Patel, MD

Geisinger Medical Center
Danville, PA

Pranav D. Patel, MD¹, Yash Shah, MD², Deepa P. Budh, MD³, Deep Mehta, MD⁴, Sahil Raval, MD⁵, Pooja Shah, MBBS, MS⁶, Benyam Addissie, MD⁷
¹Geisinger Medical Center, Danville, PA; ²Hackensack Meridian Ocean Medical Center, Brick, NJ; ³St. Barnabas Health System, Bronx, NY; ⁴St. Francis Medical Center, Trenton, NJ; ⁵Saint Peter's University Hospital, New Brunswick, NJ; ⁶Baroda Medical College, Brick, NJ; ⁷Geisinger Health System, Danville, PA

Introduction: Spontaneous Bacterial Peritonitis (SBP) incidence in hospitalized patients with chronic liver disease (CLD) and ascites varies from 10%-30% and is associated with an estimated in-hospital mortality rate of 20%. There is a paucity of data on SBP outcomes based on the etiology of CLD. Our aim is to compare in-hospital patient outcomes and healthcare utilization amongst patients with non-alcoholic steatohepatitis (NASH) related SBP and non-NASH related SBP.

Methods: We utilized the Nationwide Inpatient Sample (NIS) database from 2018 and 2019. Adult hospitalizations amongst hepatitis patients due to SBP were identified by previously validated ICD-10-CM codes. SBP patients were divided into two groups: NASH and non-NASH groups. The non-Nash group includes other common etiologies of cirrhosis like Hepatitis B, C, and Alcohol-related liver diseases. Univariate and multivariate logistic regression for categorical variables and linear regression for continuous variables were carried out to identify independent associations at p < 0.05. Statistical Analysis was performed using R studio.

Results: A total of 2033 patients met the inclusion criteria. 53% in the NASH-related SBP patient group and 70% in the non-NASH-related SBP group were men, respectively(Table1). Hypertension (51% vs 43%), hyperlipidemia (26% vs 9.5%), type II diabetes mellitus (19% vs 12%) and coronary artery disease (1.7%vs 0.5%) were significantly higher in patients with NASH vs non-NASH related SBP, respectively. In the non-NASH group, hepatitis C was the etiology most commonly associated with SBP (68%). On univariate analysis, patients with SBP in the NASH group had a lower crude mortality rate (11% vs 15%) and increased length of stay (7 days vs 6 days) as compared to non-NASH related SBP. On multivariate analysis, there was no statistically significant difference amongst outcomes parameters including crude mortality rate, total charges during hospitalization, and length of stay (Table 2).

Discussion: Patients with NASH-related SBP had more comorbidities representing an increased prevalence of metabolic syndrome in these patients. Despite this difference in disease burden, there was no significant difference in SBP-related outcomes, and outcomes were still poor in all etiology groups. Thus, SBP needs to be treated aggressively regardless of the etiology of the underlying liver disease.

Table 1	Baseline Demographics	NASH SBP, N = 1,770	Non NASH SBP, N = 8,395	p-value
	Age in years at admission	56 (46, 65)	57 (52, 63)	0.11

	Gender
	MALE	935 (53%)	5,835 (70%)	< 0.001
	FEMALE	835 (47%)	2,560 (30%)

	Hospital Bedsize			0.3
	Small	255 (14%)	1,430 (17%)
	Medium	435 (25%)	2,200 (26%)
	Large	1,080 (61%)	4,765 (57%)

	Hospital location Teaching			0.6
	Rural	115 (6.5%)	560 (6.7%)
	Urban, NonTeaching	285 (16%)	1,165 (14%)
	Urban, Teaching	1,370 (77%)	6,670 (79%)

	HOSP REGION			0.2
	Northeast	230 (13%)	1,305 (16%)
	Midwest	395 (22%)	1,490 (18%)
	South	615 (35%)	3,090 (37%)
	West	530 (30%)	2,510 (30%)


	Insurance			< 0.001
	Medicare	625 (36%)	2,855 (34%)
	Medicaid	440 (25%)	3,240 (39%)
	Private	475 (27%)	1,400 (17%)
	Self Pay	150 (8.5%)	510 (6.1%)
	No charge	5 (0.3%)	70 (0.8%)
	Other	65 (3.7%)	300 (3.6%)

	RACE			< 0.001
	White	1,190 (69%)	4,670 (57%)
	African American	155 (9.0%)	1,160 (14%)
	Hispanic	240 (14%)	1,535 (19%)
	Asian/Pacific Islander	35 (2.0%)	420 (5.1%)
	Native American	35 (2.0%)	170 (2.1%)
	Other	65 (3.8%)	275 (3.3%)


	YEAR			0.2
	2018	865 (49%)	4,440 (53%)
	2019	905 (51%)	3,955 (47%)

	Median household income			< 0.001
	$1- 24999	450 (26%)	2,985 (37%)
	$25000-34999	520 (30%)	2,240 (28%)
	$35000-44999	360 (21%)	1,850 (23%)
	$45000+	410 (24%)	1,055 (13%)

	Hepatitis_B	0 (0%)	1,095 (13%)	< 0.001

	Hepatitis_C	0 (0%)	5,730 (68%)	< 0.001

	Alcoholic_Liver_Disease	0 (0%)	1,940 (23%)	< 0.001

	Liver_Disease	1,770 (100%)	8,395 (100%)

	HTN	895 (51%)	3,615 (43%)	0.01

	HLD	460 (26%)	795 (9.5%)	< 0.001

	DM	340 (19%)	980 (12%)	< 0.001

	CAD	30 (1.7%)	40 (0.5%)	0.012

	Age_Group			< 0.001
	18-27	30 (1.7%)	50 (0.6%)
	28-37	205 (12%)	450 (5.4%)
	38-47	270 (15%)	945 (11%)
	48-57	470 (27%)	2,760 (33%)
	58-67	455 (26%)	3,195 (38%)
	68-77	240 (14%)	855 (10%)
	78-87	100 (5.6%)	125 (1.5%)
	88 and above	0 (0%)	15 (0.2%)
	Outcomes
	Inpatient Mortality	200 (11%)	1,285 (15%)	0.05
	Total charges	59,325 (36,229, 103,783)	60,908 (31,891, 117,212)	0.8
	Length of stay	7 (4, 11)	6 (3, 10)	0.008


Table 2	Outcomes (Multivariate Analysis)	aOR	Range
	Inpatient Mortality	1.35	0.91-2.01
	Total Charges	1	1
	Length Of Stay	1.01	1.01-1.02

Table: Table 1: Baseline demographics of inpatient SBP patients with NASH and Non-NASH related liver disease.
Table 2: Outcome of inpatient SBP patients with NASH and Non-NASH related liver disease.

Disclosures:

Pranav Patel indicated no relevant financial relationships.

Yash Shah indicated no relevant financial relationships.

Deepa Budh indicated no relevant financial relationships.

Deep Mehta indicated no relevant financial relationships.

Sahil Raval indicated no relevant financial relationships.

Pooja Shah indicated no relevant financial relationships.

Benyam Addissie indicated no relevant financial relationships.

Pranav D. Patel, MD¹, Yash Shah, MD², Deepa P. Budh, MD³, Deep Mehta, MD⁴, Sahil Raval, MD⁵, Pooja Shah, MBBS, MS⁶, Benyam Addissie, MD⁷. B0489 - In-hospital Characteristics and Healthcare Utilization of NASH-Related SBP vs Non-NASH-Related SBP - A Study Based on Nationwide Inpatient Database, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.